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General NPI Number Information
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NPI Number | 1215928171
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Entity Type | Individual
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Provider Name | JEVON CHRIS MITSUOKA PHARM.D, PA-C
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Gender | Male
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Dates
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Enumeration Date | 10/31/2005
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Last Update Date | 08/22/2025
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Provider Practice Location Address
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Address Line | 29351 MADEIRA LN
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City | VALENCIA
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State | CA
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Zip | 91354-1598
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Country | US
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Telephone | 661-775-7737
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Fax |
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Provider Business Mailing Address
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Address Line | 5725 RALSTON ST STE 101
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City | VENTURA
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State | CA
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Zip | 93003-6053
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Country | US
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Telephone | 661-775-7737
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 51802
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 17474
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 17474
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License Number State | CA
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